HomeMy WebLinkAboutMortgage_Gentry (3) a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ai+ FOR DEDUCTION FROM ASSESSED VALUATION _
...,---.'• S�Form 43709(R13/10-15) - .
Prescribed by Department of Local Government Finance }1
INSTRUCTIONS: Ni, Ile
To be filed in person or by mail. �L J! Faro f�7ed wnh:
FfTmg Dates: 1) Real Property Must be completed and dated In the calendar year for which the deduction is sought.
Must be Red or postmarked with the County Auditor or County Recorder of the county where the property isAU G 9 L. nty Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Properly.Must file with the County Auditor of the county ❑ �'Recorder
where the property is located dung the twelve(12)months before Mardi 31 of each year the deduction is •
See reverse side for additional instructions and qualifications.
Applicant I. conbac/••j :. -see ' „r,-.. re -.t,:) U . • ea n GIBBON LUuN L'; A��'•?Of3■
' IPAaI descrplion Reard number Page number
T..: ` I ' !—' , _ - le -®o : ' �2- .+ . ' . 0/ 7 • .33. 8
Assessed value Sal properly..of ' Mortgage,Contract indebtedness unpaid as of . Mortgage I Contract indebtedness unpaid as of Is the appirara the sole
assessmenddaLe,current year ,a,u data,amens year date of legal or equitable owner?
If no,what is his I her exact share of interest? If owned with so ��O ❑ Yes ❑ No
indicate with whom
h
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
• ❑ Real PWe� ❑ Merle tome1.1-7)
Nano:of mortgagee or contract seller 1
„oci Address of wxxtgagr..a contact seller(number and street,city,slate, ZIP code)
•
Name of assignee mortgage e or other owner or holder of age •
Address of assignee(number and street thy,state,and ZIP code)
Does applicant own property in any if yes,what county? What Taxing District? tiers ttnis died C�, t c J
other in Indiana? ❑Yes ❑No amerd f �J
A person is not entitled to this deduction unless the person has a balance on the person's mortgage t DG` i _ 3 s -
recorder's office(including any home equity fine of credit that is recorded in the county recorder's of 6
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COUNTY AUDITOR • 'IS -S U —
Deduction approved in the amount ot:
•
20 20 20 20 20 20 I 20
Signature of CoadyAafitcr County Date(month,day,year) '
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the afo entioned property on date application is filed.
!• name Date(month,day,year)
erreoly
• au/////A..���• rrr1 a (number and street,city,state,and ZIP code)
ut prized by duly executed Power of Attorney or by IC 6-1.1-12417 Date(month,day,year)
Address of authorized person (number and street aly state,and ZIP ode)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed$10,000.